Bioethics
What is Bioethics?
 Ethics is a field of study that looks at the moral basis
of human behavior
 Why do we act as we do?
 Ethics attempts to determine the best course of
action in the face of conflicting choices
 How do we decide what to do when people disagree about a
complex issue?
 Bioethics is a subfield of ethics applied to the life
sciences
 Helps us a society make decisions about how best to use new
scientific knowledge, how to make policy decisions regarding
medicines or treatments, and how we should behave with each
other
Values, Morals, and Ethics
 Values signify what is important and worthwhile. They
serve as a basis for moral codes and ethical reflection
 Morals are codes of conduct governing behavior. They
are values “put into practice” as actions
 Ethics provide a systematic, rational way to work
through dilemmas and to determine the best course of
action in the face of conflicting choices
 Today you guys will delving into an ethical discussion,
after we first define what constitutes an ethical question.
What is an Ethical Question?
 Ethical Questions have the following components:
 Often involve the words “ought” or “should,” implying
a difficult decision must be made
 There are several alternate solutions, none of that is
without some challenging or problematic aspect
 They contain conflicting moral choices and dilemmas,
and the underlying values of the people may clash
 They have no right or wrong answers based on wellreasoned justifications
Which of the following are Ethical
Questions?
 A. Is it legal to sell human kidneys in the US
 B. How does a kidney function inside the body
 C. What does my religion say about whether or not it is
acceptable to donate a kidney?
 D. Should individuals who donate a kidney choose who their
organ should go to?
 E. What type of diet allows for the best athletic performance?
 F. Is killing always illegal?
 G. Should people select the sex of their child in advance?
Other Type of Questions
 Legal – questions that ask what the law says about a particular
issue
 Scientific – questions can be explored through scientific inquiry
and observation. They rely on empirical and measurable
evidence
 Religious/Cultural – questions ask what would be in line with a
particular belief or practice, or the common practices of a
particular culture
 Personal Preference – questions relate directly to the speaker
and are often modified by cultural bias.
Ethical Group Discussion – Pandemic Flu
 Who should be saved during a flu outbreak when there is not enough
life-saving vaccine available for everybody?
 Is this an ethical question??
 Lets review the criteria:
 Often involve the words “ought” or “should,” implying a difficult decision
must be made
 There are several alternate solutions, none of that is without some
challenging or problematic aspect
 They contain conflicting moral choices and dilemmas, and the underlying
values of the people may clash
 They have no right or wrong answers based on well-reasoned
justifications
Pandemic Flu
 You have 5 minutes to read the presented
scenario and complete handout 1.1
 Now, you have 5 minutes to discuss your
responses with the person next to you
Common Approaches
 Approach #1: Save the youngest
 In choosing this students are maximizing the life span for the greatest number
of people
 Approach #2: Draw Straws
 Option values fairness
 Approach #3: Save the weakest
 Considers the special needs of vulnerable populations
 Approach #4: Save the most useful
 Saving someone who has special knowledge and/or may be able to save others
benefits a larger number of people
 Approach #5: Respect relationships
 Honoring the dignity of human beings includes acknowledging their
relationships
The Need for Facts
 In considering any ethical question, it is
important to examine the facts available, and
assess what additional information is needed
 What are the facts of this case?
 What are the “unknowns” in this case?
 Very few real-life situations will supply all the
facts
 Eventually, a decision must be made.
Real World
 Ethical questions arise whenever individuals , with their
own values and moral codes, interact within a larger
community and a decision must be made about
conflicting choices
 Should we allow embryos left over from in vitro
fertilization clinics to be destroyed for stem cell
research, if they would otherwise be discarded?
 Should human clinical trials be conducted in
populations that may not be able to afford the final
medication, even if that population benefits from the
trial?
Real World
 By learning how to recognize an ethical
question, assess the facts, listen to different
viewpoints, and make a reasoned judgment
about a course of action, it will help expand your
ability to understand and respect others point of
view
 In this class, we will be identifying and
discussing various bioethical topics throughout
the year!
Principles of Bioethics
Subjective and Objective Questions
 Draw the following scale (with labels) into
your Notebook
Purely Subjective
(all opinion)
Examples of Subjective Questions:
• What is your favorite ice cream?
• Do you like to wear sneakers?
Purely Objective
(all fact)
Examples of Objective Questions:
• What is the capitol of California?
• How many legs does an arachnid
have?
Principles of Bioethics
 Divide yourselves into 6 groups
 Each group will receive a scenario
 You have 5 minutes to plan a 30 second skit that
demonstrates your groups parent/child interaction (23 people will actually perform skit)
 Remember! It is helpful to voice the ideas inside a
person’s head by saying them out loud
Application of the Principles of Bioethics
 The three principles we just developed are built upon
familiar values respected by a variety of different
cultures.
 Think back to how you made your decisions about
whom to give the vaccine yesterday…
 Working in your same groups of six I am going to assign
each group a principle and based on your groups
principles you will decide which 2 people to save.
 Be prepared to share!
Revisiting our Approaches…
 #1: Save the Youngest
 Maximize and Minimize
Harms
 #2: Draw Straws
 Justice
 #3 Save the Weakest
 Respect for Persons
 #4 Save the Most Useful
 Maximizing Benefits
and Minimizing Harms
 #5 Respect Relationships
 Respect for Persons
Homework
Read Dennis’s Decision
Complete the handout titled: Focus
on the Principles
Finding the Stakeholders
Dennis’s Decision
 Last night you should have read Dennis’s
Decision and completed the worksheet on the
back side…
 What do you think the ethical question is?
 Should Dennis be allowed to reject life-saving
treatments?
Facts and Questions
 Working in groups of 4, complete Part II:
Facts and Questions of Handout 3.3
Be prepared to share with the class!
Stakeholders
 Working in your same groups, brainstorm a list of individuals
and/or institutions that have a stake in the outcome(DON’T
WRITE THESE ON YOUR WORKSHEET QUITE YET).
 We call these people/institutions stakeholders
 Let’s narrow this list down to the 4 stakeholders that are most
affected by the decision (write these on your worksheet!)
 Dennis
 His biological parents
 His aunt
 The doctors
Stakeholders
 I am going to assign each group a stakeholder…
 Working as a group, use the Values Definition Table to consider that values
that a stakeholder brings to the case
 What does the stakeholder value?
 What are his concerns?
 What does she care about?
 Try and put yourself in each of the stakeholders shoes!
 If your stakeholder group alone were to make the decision, what would you
choose? Why?
 Do any of the Principles of Bioethics support your position?
 Be prepared to present your response to the class!
Values & Principles – What’s the
Difference?!
 Remember our continuum from the previous day…where would
values go?
 While many values are highly respected across cultures, values
are shaped by personal experience and individual background.
 This tips values towards the SUBJECTIVE end of the
continuum
 Principles, when used in conjunction with the facts of a case and
consideration of stakeholder viewpoints, help provide a
systematic, rational way of working through an ethical question.
 This tips bioethical principles towards the OBJECTIVE end of
the continuum
Homework
 Choose a combination of values from the list below
and write a short (1-2 paragraph), imaginary scenario in
which those values conflict and a decision must be
made:
 Honesty vs. Friendship
 Compassion vs. Utility
 Generosity vs. Financial Security
 Sacrifice vs. Personal Happiness
 Cooperation vs. Independence
 Status vs. Justice
Making a Strong
Justification
Dennis’s Decision
 Yesterday in class we identified the
stakeholders in Dennis’s situation
Dennis
The doctors
Biological Parents
Dennis’s Aunt
Justification
 The reasons given to support a position, or
claim, are known as the justification
 Often times, in ethical dilemmas people jump
to their decision without a sense of
justification
 “I don’t like it,” “That’s not the way it should be
done,” “I just don’t think its right”
 Are these good justifications? Why? Why not?
Weak Justifications
 Are based on subjective opinion
 Rely on an undefined “feeling”
 Can’t be substantiated with facts or science
 Are based on a cultural bias that is not universal
 Are not relevant or logically linked to the facts
of the case
Silent Debate
 In your pair, decide who will represent FOR (YES) position and
who will represent the AGAINST (NO) position
 Instructions for Silent Debate
 There is no talking once the silent debate starts
 Note whether you are making an argument FOR or AGAINST
the issue
 If you change the type of argument you are making, you may
draw a line to separate your ideas.
 For example, the first argument about school uniforms is about
individuality, and the second argument is about money
 Add additional sheets of paper as necessary
Strong Justifications
 A clearly-stated position (claim) that relates directly to the
ethical question.
 Reference to important facts and science content of the case
 Reference to one or more Principles of Bioethics or other
ethical considerations
 Consideration of how other people will be impacted by the
decision.
 Consideration of the strengths and weaknesses of alternative
options.
What are the options?
 Dennis’s wishes could be honored and he receives no blood transfusions. He is
allowed to die.
 The doctors are allowed to treat their patient as they see fit, in his best interests.
Dennis receives blood transfusions against his wishes, even if that means the
medical staff must restrain him during transfusions.
 Dennis is given sedatives to incapacitate him during blood transfusions. This
allows him to not give his consent to receive transfusions (thereby honoring his
beliefs), yet allows the doctors to “do good” and treat their patient.
 The parental rights of the biological parents are legally reinstated, thereby giving
them the authority to override the wishes of Dennis and his aunt and receive
blood transfusions.
 Dennis is not given chemotherapy in the first place, allowing his disease to take its
natural course without the need for blood transfusions.
 Dennis is encouraged to spend time with his biological parents to build that
relationship; they convince him to receive the transfusion.
Justify the Answer
 Find A Decision for Dennis
 Read justification A
 Has a decision been made?
 Are facts from the case included in the
justification?
Your decision and justification
 Complete handout 4.3
 Be sure to write in complete sentences!
Putting it all together
Ethical Question, Facts, and Stakeholders
 Read Case Study: The
Time and the Place
 What should be the
ethical question?
 Should Rezip conduct
this clinical trial
research?
 Who are the
stakeholders?

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










You (the doctor)
Rezip
The children
The families of the children
The families of the children
Other sick people in Kano
The US Government
The Nigerian Government
Doctors without Borders
Rezip shareholders
Other pharmaceutical companies
Other doctors employed be Rezip
Kano ethics committee
Stakeholders
 Who are the top four stakeholders that are
most affected by the decision?
 You (the doctor)
 The sick children
 Rezip
 Kano
 Complete the stakeholders section of
handout 5.2
Stakeholders
 Each group of 4 students will be assigned a particular
stakeholder
 Using the Values Definition Table and The Principles
of Bioethics Handout answer the following questions
from the Point of View of your stakeholder:
 How does respect for persons relate to the group?
 Maximize benefits/minimize harms?
 Justice?
 Do all the principles apply equally to each
stakeholder group?
“Mixed” Stakeholder Groups
 We are going to form different groups of 4, with
one representative from each stakeholder group
 Each stakeholder should share their values and
concerns in turn
Written Justification
 Using the decision chart on Handout 5.3, write a
thorough justification
 Share your justification with your elbow partner
Would you feel differently if you knew…
 The outcome of the trial?
 11 children died during the drug trial—five of whom had been given
Trovan, six of whom had been given the other approved antibiotic.
 Families of the children who received Trovan claim that many of
them suffered serious side effects from the drug, such as brain
damage and organ failure. Rezip claimed that these effects were
from the meningitis itself.
 Rezip claimed that Trovan clearly saved lives since the survival rate
from the epidemic went from 80% at the beginning to 94% after
the trial.